Name: Social Work Research Publisher: National Association of Social Workers Audience: Academic; Trade Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2009 National Association of Social
Workers ISSN:1070-5309

Issue:

Date: Dec, 2009 Source Volume: 33 Source Issue: 4

Topic:

Event Code: 290 Public affairs

Geographic:

Geographic Scope: Iowa Geographic Code: 1U4IA Iowa

Accession Number:

212686851

Full Text:

The purpose of this research was to evaluate the relationship
between past traumatic events and the level of current traumatic stress
among mothers experiencing homelessness. The data for this study were
gathered from 75 homeless mothers between May 2006 and October 2006
using a cross-sectional survey design with purposive sampling. All
mothers were interviewed in a face-to-face, semistructured interview
format using standardized questionnaires and measures, including the
Global Appraisal of Individual Needs-Quick, Williams' Life History
Calendar of Traumatic Events, the Traumatic Stress Index, and the
Davidson Trauma Scale. The mothers ranged in age from 18 to 50.
Forty-four percent were white, 21% were African American, 3% were Native
American, 31% identified themselves as multiracial, and 9% reported
Hispanic ethnicity. The analysis indicated that the average level of
traumatic stress from past traumatic events and the number of
distressing (but nontraumatic) events did not influence current
traumatic stress; however, the number of past traumatic events
significantly influenced the current level of traumatic stress among
mothers experiencing homelessness. Recommendations for future research
include investigating how traumatic stress affects a mother's
ability to locate, find, and retain housing and how trauma interventions
influence mothers to exit homelessness.

Between 30 percent and 40 percent of the estimated 3.5 to 4.5
million homeless people in the United States consist of families, mostly
mothers with small children (Urban Institute, 2001; U.S. Conference of
Mayors, 2007). Many of these mothers struggle daily to keep their
children safe, warm, fed, and together as a family. At the least, these
mothers have suffered the trauma of losing their home, a place of
familiarity that provided a sense of security and grounding for them and
their children. At the most, becoming homeless may have been the most
recent in an accumulation of tragic events that these mothers have
experienced. This study investigated traumatic stress among mothers
experiencing homelessness, including whether past events influence
current levels of traumatic stress among mothers.

Obtaining a better understanding of traumatic stress among mothers
experiencing homelessness is important because of the debilitating
effects traumatic stress can have on someone's ability to function.
When a person experiences an intense traumatic reaction, the autonomic
nervous system reacts in such a way that the higher functioning areas of
the brain instinctively give way to the basic survival regions of the
brain (Lanius et al., 2001). In effect, higher cognitive functioning is
shut down or severely compromised. This automatic response can seriously
impair decision-making capacities and communication skills of the
traumatized individual. It is not surprising that this effect could have
tremendous implications for homeless mothers who have experienced
traumatic stress as they attempt to locate housing, hold down a job, or
navigate social services on their own. Increasing our understanding of
the prevalence of traumatic stress among homeless mothers and how past
traumatic events may affect current traumatic stress could provide
useful knowledge to social workers in their efforts to assist mothers
who are homeless and suffering the effects of trauma. But what is
traumatic stress? How is traumatic stress different from normal stress?

LITERATURE REVIEW

Traditional Stress Theory

Traditional stress theory originated with physician and pioneering
researcher Hans Selye (Critelli & Ee, 1996; Pearlin, Lieberman,
Menaghan, & Mullan, 1981). For Selye (1974), the main elements of
stress theory included stressors and stress. Selye (1974) defined a
stressor as anything that produces stress, with some stressors being
pleasing (for example, the birth of a baby, a passionate embrace) and
other stressors being unpleasant (for example, the loss of a job, having
the flu); stress, however, is defined as "the nonspecific response
of the body to any demand made upon it" (p. 27). Similar to
stressors, stress can be pleasant or unpleasant. The term eustress
refers to pleasant or beneficial stress, such as that which results from
creative work or competition (Critelli & Ee, 1996); the term
distress refers to unpleasant stress, such as that which results from
receipt of bad news. According to Selye (1974), stress is both
unavoidable and necessary in everyday living, as "complete freedom
from stress is death" (p. 32).

The general idea of traditional stress theory is that living beings
attempt to change and adapt to a continual barrage of stressors in an
effort to reduce the effects of stress and restore a homeostatic state
(Selye, 1974). During his research, Selye noticed that the body reacts
to eustress and distress in the same way. First, the body experiences an
alarm reaction. Next, the body enters a stage of resistance and attempts
to cope with and adapt to the stress. Finally, if the stressor continues
long enough, the body runs out of adaptive energy and becomes exhausted.
Selye (1974) acknowledged that this cycle repeats itself throughout life
"whenever we are faced with a demand" (p. 81). In addition,
Selye noted that our reactions to stress are influenced by our
individual adaptive energy stores, knowledge about the stressor, past
experience, genetic and physical makeup, and environmental conditions.

While testing his theory in the laboratory, Selye discovered
several important physiological processes that help the body restore
homeostasis during stress (Vermetten & Bremner, 2002; Yehuda, 1998).
His findings have been replicated countless times over the past
half-century and have become so widely accepted that these physiological
measurements are "considered de facto proof that stress ha[s]
occurred" (Yehuda, 1998, p. 101). Consequently, when posttraumatic
stress disorder (PTSD) gained recognition in the latter 20th century,
researchers used their knowledge of stress and distress to formulate
hypotheses for PTSD. Because previous research had shown that higher
distress produced higher releases of certain chemicals, researchers
expected to find a similar relationship between trauma severity and
those chemicals (Yehuda, 2001). To their surprise, the results revealed
the opposite, with individuals with PTSD having very different
physiological reactions than individuals experiencing distress (Griffin,
Resick, & Yehuda, 2005; Neylan et al., 2005;Yehuda et al., 2005;
Yehuda, Gorier, Halligan, Meaney, & Bierer, 2004). Researchers have
since found additional evidence that stress and traumatic stress have
distinct etiologies (Yehuda, 1998).

Since these discoveries, behavioral patterns have been investigated
to further differentiate stress from traumatic stress. According to
Selye (1974), ordinary stress is unavoidable and necessary to everyday
riving. If this is true, then behaviors related to stress could be
deemed part of the usual behavior of people in everyday fife. When a
person experiences traumatic stress, however, an unusual set of
behaviors may occur. These behaviors may be identified as traumatic
stress, which can lead to PTSD (American Psychiatric Association [APA],
2000).

PTSD

Traumatic stress encompasses the physiological, psychological, and
behavioral reactions an individual has to an event that initially
elicited feelings of intense fear, helplessness, or horror (APA, 2000).
An event might be directly experienced (for example, violent physical
assault, military combat), witnessed (for example, a severe car
accident), or learned about (for example, learning that your child was
sexually molested). If the physiological, psychological, and behavioral
reactions last longer than a month and meet specific criteria, the
individual could be suffering PTSD (APA, 2000). These criteria include
exposure to an actual or perceived traumatic event in which the
individual's response includes fear, helplessness, or horror;
perceived re-experiencing of the event; avoidance of people, places,
things, or situations associated with the event; hyperarousal; symptoms
of re-experiencing, avoidance, and arousal lasting longer than one
month; and substantial impairment in important areas of life functioning
(APA, 2000). PTSD is considered acute if symptoms last less than three
months and chronic if symptoms last at least three months, but it can
also be delayed, with symptoms appearing at least six months after the
event.

Few studies have investigated PTSD among homeless women, and only
one study could be found that looked at, among other things, PTSD rates
among homeless mothers. The Worcester Study (Bassuk, Buckner, Perloff,
& Bassuk, 1998; Weinreb, Buckner, Williams, & Nicholson, 2006)
investigated health, mental health, and substance abuse disorders of
mothers who were homeless in Worcester, Massachusetts, in 1993 and 2003.
In 1993, the past month rate of PTSD among the sample (n = 220) was
17.5%. By 2003, the rate among a sample of homeless mothers in Worcester
(n = 148) had increased to 42.2%. These rates are substantially higher
than the documented rate of lifetime PTSD among women in the general
population, at 12% (APA, 2000). Additional studies are needed to
corroborate the PTSD rates among mothers experiencing homelessness.

Multiple Traumas

Some researchers have suggested that multiple traumatic events may
increase the level of traumatic stress among individuals (Brewin,
Andrews, & Valentine, 2000; Resick, Yehuda, Pitman, & Foy,
1995). Only one peer-reviewed study could be located that specifically
investigated the number of potentially traumatic lifetime events
experienced by homeless mothers (Zugazaga, 2004), but the research
considered only trauma exposure and did not include measures for
traumatic stress. Nevertheless, the study found that the homeless women
with children (n = 54) had endured an average of 12 exposures to
potentially traumatizing life events, which is more than twice the
number of exposures to potentially traumatic events in the general
population, at five exposures (Breslau et al., 1998). Other research has
suggested that a higher percentage of homeless women experience
potentially traumatizing events compared with the general population.
For example, studies have shown that homeless women experience
significantly higher rates of adult victimization than do
low-income-housed women (Kushel, Evans, Perry, Robertson, & Moss,
2003) and that homeless women are significantly more likely to have been
sexually assaulted and have higher levels of distress than the
low-income-housed women, (Ingram, Corning, & Schmidt, 1996).
However, few studies have investigated multiple traumatic events among
homeless mothers, and research could not be located that examined how
multiple traumatic events influence current levels of traumatic stress
among mothers experiencing homelessness.

The purpose of the present research was to evaluate the
relationship between past traumatic events and the level of current
traumatic stress among mothers experiencing homelessness. Specifically,
this research examined the following three questions: (1) Does the
number of past traumatic events affect the level of current traumatic
stress among homeless mothers? (2) Does the average level of traumatic
stress of past traumatic events affect the level of current traumatic
stress among homeless mothers? (3) Does the number of past distressing
(nontraumatic) events affect the level of current traumatic stress among
homeless mothers?

METHOD

Participants and Setting

Participants for this study were recruited from mothers who had
applied to Humility of Mary Housing, Inc. (HMHI), a nonsectarian social
services agency that provides a supportive transitional and permanent
housing program to homeless single-parent families. HMHI is located in
Davenport, Iowa, the largest of four adjoining cities known collectively
as the Quad Cities, and is the largest primary provider of supportive
transitional and permanent housing to homeless single-parent families in
the Quad Cities region. The agency was selected for data collection
because HMHI receives 350 to 450 applications from homeless
single-parent families per year. Participants for this study were
eligible if they were female, were at least 18 years of age, were
homeless, were the head-of-household for their family, were able to
speak English, and had at least one child under the age of 18. All study
procedures were approved by the Institutional Review Board at the
University of Iowa.

Research Design

The data for this study were gathered between May 2006 and October
2006 using a cross-sectional survey design with purposive sampling.
Seventy-five mothers were interviewed by a licensed, MSW-level
researcher in a face-to-face, semistructured interview format using
standardized questionnaires and measures. This format allowed the
interviewer to watch for and address any negative reactions to the
questionnaires or measures, such as excessive psychological discomfort
or trauma-related symptoms (for example, dissociation,
re-experiencing).Throughout the interview, the interviewer used
trauma-informed practices, such as preparing the mother for potentially
difficult questions and reminding the mother that she was in control of
the interview, could skip any questions or assessments, or stop the
interview at any time. In all cases, mothers completed the entire
interview.

Assessment Procedures

After the study was explained and the consent document signed, the
Global Appraisal of Individual Needs--Quick (GAIN-Q) (Dennis, Titus,
White, Unsicker, & Hodgkins, 2002) was introduced and completed,
with the interviewer reading the questions and marking the responses.
Williams' Life History Calendar (LHC) (Williams, 2007) was then
introduced and completed. The LHC approach was chosen over a regular
interview or survey approach because research has shown that the LHC
helps respondents to provide more detailed and accurate retrospective
data than either a structured interview or a survey method (Freedman,
Thornton, Camburn, Alwin, & Young-DeMarco, 1988; Lin, Ensel, &
Lai, 1997; Yoshihama, Gillespie, Hammock, Belli, & Tolman, 2005).

Next, the mother was asked to identify events in her life that were
particularly upsetting to her. The interviewer listed events named or
described by the mother in a separate section on the LHC. The mother was
then asked to identify the event from the list that was currently most
disturbing to her. This event was used to measure the mother's
current level of traumatic stress using the Davidson Trauma Scale (DTS)
(Davidson, 1996). After the DTS was completed, the participant completed
a Traumatic Stress Index (TSI) (Dennis, 1998) for each of the events
listed. At the end of the interview, a collection of counseling
referrals was reviewed and the mother was compensated $20 for her time
and thanked for participating in the study.

Williams' LHC. Williams' LHC was created by the first
author specifically for the broader study and follows the general format
of other LHCs (Freedman et al., 1988; Lin et al., 1997; Yoshihama et
al., 2005). The calendar is in the form of a large grid in which the
columns represent time (participant lifetime in years) and the rows
represent different domains, activities, or events of interest. Domains
included residence, education, children, employment, substance use,
physical health, mental health, and abuse history. For each domain, the
interviewer asked the respondent when an event occurred and for how
long, and the interviewer filled in the appropriate cells of the grid.
Codes were used to delineate specific information (for example, if the
row represented education, the letter Q or G in a cell would designate
when the respondent quit or graduated, respectively). This process
continued until all of the appropriate rows of the grid had been
addressed.

DTS. The DTS (Davidson, 1996) is a 17-item assessment instrument
for adults that measures the frequency and severity of past-week PTSD
symptoms according to Diagnostic and Statistical Manual of Mental
Disorders (4th ed., text rev.) (DSM-IV-TR) (APA, 2000) criteria for one
identified event. Specifically, items 1 to 4 and item 17 match criteria
B for PTSD (recurrent images, thoughts, nightmares related to the
event), items 5 to 11 match criteria C (avoidance and emotional
numbing), and items 12 to 16 match criteria D (hyperarousal). Items are
measured on a scale ranging from 0 to 4 for both frequency (not at all,
once only, 2 to 3 times, 4 to 6 times, every day) and severity (not at
all distressing, minimally distressing, moderately distressing, markedly
distressing, extremely distressing). Example questions on the DTS
include "Have you had distressing dreams about the
event?"" Have you been upset by something that reminded you of
the event?" and "Have you been avoiding thoughts or feelings
about the event?" The highest possible score on the DTS is 136,
with 40 as the cut point score for clinical PTSD (Davidson et al.,
1997). The DTS takes less than 10 minutes to complete.

The DTS has been tested in both general and clinical populations
and across ethnic groups (Davidson et al., 1997; Davidson, Tharwani,
& Connor, 2002). The DTS has high internal consistency
(Cronbach's alpha ratings are .97 and .98 for the frequency and
severity scales, respectively, and .99 for all 17 severity and frequency
items together) (Davidson et al., 1997).The DTS has shown good
convergent and discriminant validity and has proven to be significantly
correlated (p < .001) with the Clinician-Administered PTSD Scale
(.78) (Blake et al., 1995), the Impact of Event Scale (.64) (Weiss,
2004), and the Symptoms Checklist 90-Revised (.89) (Davidson et al.,
1997). The DTS was chosen over other measures because it is brief, has
good reliability and validity, and has been tested in both general and
clinical populations and across ethnic groups.

TSI. The TSI is an internally consistent (Cronbach's alpha =
.92) 13-item scale that counts the number of traumatic stress symptoms
related to memories of past traumatic events. The scale is based on a
subset of items from the Civilian Mississippi Scale for PTSD (Norris
& Perilla, 1996; Vreven, Gudanowski, King, & King, 1995),
excluding the reverse-scored items deemed problematic in prior research
(Scott, Sonis, Creamer, & Dennis, 2006). TSI items relate to the
DSM-IV-TR (APA, 2000) criteria for PTSD, including symptoms of
re-experiencing (for example, "You had nightmares about things in
your past that really happened"), emotional numbing (for example,
"It seemed as if you had no feelings"), increased arousal (for
example, "You lost your cool and exploded over minor, everyday
things"), and impairment in functioning (for example, "You
felt like you could not go on"). Previous research indicates
concurrent validity between the TSI and blind psychiatric diagnoses of
traumatic disorders (Jasiukaitis & Shane, 2001). Because scores of 5
or higher indicate traumatic stress levels associated with a traumatic
stress disorder (Chestnut Health Systems, 2002), events with scores of 5
or higher were categorized as traumatic events. Events with scores lower
than 5 were categorized as distressing events. Norms and confirmatory
factor analysis are available (Chestnut Health Systems, 2002).

Data Analysis Procedures

The data were analyzed using STATA SE 8 (Statacorp, 2003). The
research questions were investigated using ordinary least-squares
multiple regression techniques. For the multiple regression model, the
dependent variable was the DTS score, which measured the current level
of traumatic stress. The independent variables in the model included
number of past traumatic events, average TSI score of past traumatic
events, and number of past distressing events. The participant's
age at the time of the interview was controlled because participant age
could influence the number of events experienced, and the number of
months since the DTS event was controlled because some mothers
identified recent events and others identified events that occurred
decades ago. All regression diagnostic testing, including tests
examining multicollinearity (mean variance inflation factor = 1.52,
minimum [min] = 1.16, maximum [max] = 2.05), model specification using
Ramsey's regression specification error test IF(3, 66) = 0.76,p =
.52] and the link test (hatsq = 0.005, p = .28), nonlinearity (using
scatter plots of the residual against predictor variables; contact first
author for plots), heteroscedasticity (Bruesch-Pagan/ Cook-Weisberg [chi
square] = 1.77, p = .18), normality of residuals (Shapiro-Wilk z = 0.17,
p = .43), and influential outliers (leverage versus squared residual
plot; contact first author for plot) indicated that the assumptions of
the model were met.

RESULTS

The sample consisted of 75 homeless mothers ranging in age from 18
to 50 (M = 30 years, SD = 8.1 years). Forty-four percent of the mothers
were white, 21% were African American, 3% were Native American, 31%
identified themselves as multiracial, and approximately 9% reported
Hispanic ethnicity. Eighty percent of the mothers had at least a high
school diploma or equivalent. Seventy-six percent of the mothers had
either worked or attended school in the past 90 days, with those mothers
working an average of 45 of the past 90 days. Fifty-five percent of the
mothers had never been married, 16% were married but separated, and 29%
were divorced. Eighty-nine percent of the mothers were living with their
children at the time of the interview, with the remaining mothers
reporting plans to reclaim physical custody of their children after
locating stable housing. The number of lifetime homeless episodes ranged
from one to 10, with a median of two episodes.

Current Level of Traumatic Stress

Mothers identified a single event that was most disturbing at the
time of the interview, and this event was used to measure their current
level of traumatic stress. Sixty-one percent of mothers identified an
event that occurred within the past year, and 71% identified an event
that occurred within the past two years. The most often cited event
involved abuse (for example, physical, sexual, emotional). Nearly 67% of
the mothers reported scores of 40 or higher on the DTS (M = 56.2, Mdn =
56.0, SD = 33.5, min = 0, max = 125), thus indicating that nearly
two-thirds of the mothers were suffering PTSD at the time of the
interview.

Fifty-two percent of the mothers identified an event that occurred
prior to becoming homeless, with 72% of those having a DTS score
indicating PTSD. Of the 44% identifying an event that occurred during
the current homeless episode, 61% had a DTS score indicating PTSD. No
differences were found between mothers identifying their most disturbing
event before or after becoming homeless among DTS scores (t = -0.28,p =
.79) or presence of PTSD [[chi square] (1, N = 75) = 0.96,p = .33].

The research questions were investigated using a multiple
regression model that regressed the mother's current traumatic
stress score on the number of past traumatic events, average traumatic
score on past traumatic events, and the number of past distressing
events, controlling for age and number of months since the DTS event
(that is, the event used to measure the current level of traumatic
stress) occurred. The overall model was significant [F(5, 69) = 10.18, p
< .001] and explained 38% of the variance in the mothers' level
of current traumatic stress (see Table 1).

The analysis indicated that as the number of past traumatic events
increased, the levels of current traumatic stress among the mothers also
increased, holding all else constant; specifically, for every additional
past traumatic event the mother experienced, the level of current
traumatic stress increased by nearly three points (p < .001), holding
the average level of traumatic stress of past traumatic events and the
number of distressing events constant. In fact, for every standard
deviation increase in the number of past traumatic events (SD = 5.7
events), the level of current traumatic stress increased by more than 15
points on the DTS, holding the average score of past traumatic events
and the number of distressing events constant. For the remaining
research questions, the average level of traumatic stress of past
traumatic events and the number of distressing (but nontraumatic) events
was not associated with the level of current traumatic stress among the
mothers (see Table 1).

DISCUSSION

The high number of homeless families in the United States suggests
that more work is needed in understanding the problems and difficulties
that homeless families face. One potential problem that has received
little attention in the research literature is traumatic stress among
mothers experiencing homelessness. Because high traumatic stress is
known to have debilitating effects on the lives of people, and because
prior research indicates that many homeless mothers have experienced
difficult and potentially traumatic events prior to becoming homeless,
past events may influence the level of current traumatic stress among
homeless mothers. The purpose of this research was to explore the
relationship between past traumatic events and the level of current
traumatic stress among mothers experiencing homelessness.

This study found that more than two-thirds of the mothers in the
sample were suffering from PTSD at the time of the interview and that
most mothers had suffered multiple traumatic events during their
lifetimes. When asked to identify the event that was most disturbing to
them at the time of the interview, the majority of mothers identified an
event that occurred before they became homeless. That the majority of
mothers perceived events that occurred prior to homelessness as more
disturbing than either homelessness or events that occurred during
homelessness underscores the impact of past traumatic events on mothers
experiencing homelessness. In addition, mothers in the study had
experienced an average of 12 distressing or traumatic events in their
lifetime--which is more than twice the number of events identified by
women in general community samples (Breslau et al., 1998)--and more than
two-thirds of those events could be categorized as traumatic events.
Thus, a contribution of this research is the effort to press beyond
prior research (which considered only trauma exposure) by attempting to
measure whether the past events were distressing or traumatic for the
mother.

The results of differentiating between traumatic and distressing
events were revealing, as the number of past traumatic events
significantly increased current traumatic stress, but the number of past
distressing (that is, nontraumatic) events had no influence. Hence,
differentiating between traumatic and distressing past events was
important to assessing the potential influence of past events, with
significance resting specifically with the number of past traumatic
events. This is important because it demonstrates that trauma exposure
does not automatically equate to traumatic stress. Therefore, future
research should differentiate between distressing and traumatic past
events.

Implications for Social Work Practice

Overall, the current findings support existing theory and research
in addition to advancing our knowledge of traumatic stress among mothers
experiencing homelessness. Such findings are important to advance future
research and clinical practice. Specific to clinical practice, social
workers assisting homeless mothers must attend to the needs relating to
homelessness; however, the fundamental principle of social work practice
of beginning where the client is suggests that workers should also help
mothers cope with the traumas they have experienced. Social workers
working with people experiencing homelessness should assume that all
people experiencing homelessness have been exposed to trauma; therefore,
social workers should receive training in and make use of
trauma-informed and trauma-sensitive practice.

These findings also have implications for social work
administrators. Administrators of social service agencies providing
services to the homeless population are often forced to focus primarily
on housing and employment issues, largely due to funding limitations and
related political ideologies. Because high levels of traumatic stress
may interfere with a mother's ability to maintain stable housing or
employment and because prior research indicates that the earlier
traumatic stress is addressed the better the outcomes for traumatized
individuals (Langill, Ingargiola, Schwartz, & Kutyla, 2005), this
study provides evidence that may help administrators justify funding
requests and budgetary changes for staff training in early trauma
identification and for developing appropriate services to address
traumatic stress. These changes could substantially improve the chances
for long-term housing and employment of homeless mothers.

Social work researchers and practitioners must work together to
develop, implement, and evaluate evidence-based trauma interventions
appropriate for mothers experiencing homelessness. Although much work
needs to be done, social workers can help mothers who are traumatized
and experiencing homelessness through rigorous research and appropriate
social work practice skills. Together, social work researchers,
practitioners, and their allies can advance the knowledge base to
develop ways to help traumatized mothers experiencing homelessness.

Strengths and Limitations of the Research

The strengths of this research include the face-to-face
semistructured interview format, which allowed the interviewer to watch
for and address any negative reactions to the questionnaires or
measures, such as heightened psychological discomfort or trauma-related
symptoms (for example, dissociation, re-experiencing), and to reduce the
incidence of missing or incomplete response sets. This research also has
limitations. Because homeless mothers are generally a hidden population,
generalizing the responses from this sample to the larger population of
homeless mothers is difficult. The representativeness of the sampling
frame is unknown for the nationwide female homeless population. Also,
purposive sampling limits the generalization of the study, as does a
single site study with a smaller sample.

CONCLUSION

This study investigated traumatic stress among mothers experiencing
homelessness, including how past events were associated with increased
current levels of traumatic stress among the mothers. Although the
average level of traumatic stress of past traumatic events and the
number of distressing (but nontraumatic) events did not influence
current traumatic stress among the mothers, the number of past traumatic
events was associated with the current level of traumatic stress among
mothers experiencing homelessness. These findings indicate that
differentiating between distressing and traumatic past events may
improve the precision and validity of the research. Recommendations for
future research include measuring the level of traumatic stress for past
events to strengthen the rigor of research with traumatized mothers
experiencing homelessness, investigating how traumatic stress affects a
mother's ability to locate, find, and retain housing and how trauma
interventions influence the progress of mothers to exit homelessness.

Lin, N., Ensel, W. M., & Lai, W. G. (1997). Construction and
use of the life history calendar: Reliability and validity of recall
data. In I. H. Gotlib & B. Wheaton (Eds.), Stress and adversity over
the life course (pp. 249-272). New York: Cambridge University Press.

Zugazaga, C. (2004). Stressful life event experiences of homeless
adults: A comparison of single men, single women, and women with
children. Journal of Community Psychology, 32, 643-654.

Julie K. Williams, PhD, ACSW, LMSW, is codirector, Humility of Mary
Housing, Inc. & Humility of Mary Shelter, Inc., 1228 East 12th
Street, Davenport, IA 52803, and adjunct assistant professor, University
of Iowa, Iowa City, IA 52241; e-mail: julie-k-williams@uiowa.edu. James
A. Hall, PhD, LISW, is dean and professor, School of Social Work,
University of Alabama, Tuscaloosa. This study was funded by the Social
Sciences Funding Program through the University of Iowa. Address
correspondence to Julie K. Williams, 1228 East 12th Street, Davenport,
IA 52803.